SIM update

The SIM steering committee reviewed final recommendations from their work groups yesterday. The SIM project is developing payment and care delivery models for at least 80% of state residents – 3 million people or more and $30 billion in CT health spending. The recommendations are very detailed and specific, but they maintain that there is still an opportunity for revision. Advocates are concerned that the decision-making groups lacked consumer input, and that the process was largely conducted out of public view over a short few months in the summer. The state intends to apply for up to $60m in federal funding to implement the plan.  Most troubling, the plan includes moving 80% of state residents into a total-cost-of-care payment model within 5 years. Total-cost-of-care gives providers “responsibility for the value of patient care by tying a portion of payment to achievement of total cost and quality metrics.” It could include “gain sharing, full risk sharing, and/or capitation.” Proponents acknowledge that CT does not now have the monitoring infrastructure to ensure that savings are not achieved by denying appropriate care. Advocates are urging the state for a plan modification that requires a meaningful quality monitoring system be in place before any provider risk dollars attach. It is also critical that any incentive payments (or capitation withholds) be contingent on meeting meaningful, not minimal, quality standards. CT is well behind other states in capacity to measure quality and in performance.  SIM leaders do intend to create a metrics workgroup to develop quality standards. Hopefully this is a more diverse, transparent committee with all stakeholders represented.

Access Health CT rates up sharply, CID review and competition helped

Today’s CT Health Insurance Exchange/Access Health CT board meeting included a report from Wakely actuaries hired by the exchange to review rate proposals from health plans applying to offer coverage in the exchange. According to Wakely, plans have filed numerous revisions lowering their rate proposals, largely in response to each other and questions from the CT Insurance Dept. in their review. Despite that, in contrast to many other state exchanges, unsubsidized rates will be rising sharply from this year’s level. In examples comparing 2013 premiums with 2014 for five consumer examples, impact varied considerably. For example, single males age 21 not eligible for subsidies (over $45,900 annual income) can expect premiums to more than double for a bronze plan. Half the examples of people eligible for modest subsidies will also see their premiums rise, also more than doubling for that single young man now at 350% of the Federal Poverty Level. However some consumers eligible for the most generous subsidies, may see no premiums. While assumptions the rates are based on vary widely between plans, the final rates are remarkably similar with fairly little price difference between plans. Most plans that will be offered on the exchange are bronze level (covering 60% of medical costs on average). Of the individual coverage examples given by Wakely, the lowest premium cost was from Aetna in 14 of 15 examples.

In other news, the exchange announced they have hired a director for the All Payer Claims Database, Tamim Ahmed, PhD Economics. He has experience in data analysis and risk adjusting rates.

ConnectiCare withdraws SHOP exchange proposal

ConnectiCare has notified Access Health CT, our state’s health insurance exchange, that they are withdrawing their proposal to participate in the SHOP exchange. This leaves only three insurers in the small business portion of the exchange – Anthem, United and HealthyCT. ConnectiCare still intends to participate in Access Health CT’s individual exchange along with Anthem, HealthyCT, and Aetna. The SHOP exchange is expected to enroll approximately 40,000 people, far less than the 200,000 or more people expected to enroll in individual exchange coverage. 

An ACA primer for CT

Arielle Levin Becker of the CT Mirror has drafted a sensible, brief FAQ on health reform, what is coming in January and what it means for people who don’t read Health Affairs for a living. She has done an expert job of distilling the confusion into an accessible resource. Thank you Arielle.

HealthyCT lowers rates in insurance exchange

Healthy CT, the new co-op insurer created with federal support under the ACA, has revised their proposed premiums for the CT Health Insurance Exchange, Access Health CT. The new rates, much lower than their competitors, will average $271 per month for individuals and $408 for small businesses. Those individual rates will vary between $111 and $1,080 based on age, geography and which plan they choose. Competing plan premiums will average $364 to $424 monthly. HealthyCT’s lower individual premiums, down 36% from their original proposal, resulted from new data about the likely health of enrollees in the exchange. 

Entertaining new video explains Obamacare implementation

Medicaid Council update

Last Friday’s Medicaid Council meeting focused on ACA primary care rate increases for 2,277 CT providers including MDs practicing pediatrics, internal medicine, family medicine and some specialties and APRNs for preventive care services. Effective January 1^st but implemented July 1^st, the ACA increased these rates to Medicare levels, with 100% federal funding through 2014. On average, rates are almost doubling,;for example rates for code 99203 - new patient visit will rise from $66.40 to $123.53. The rate increases are significant, impressive and universally welcomed by Council members. However hesitations about fully realizing the impact in increased CT provider Medicaid participation were raised concerning the delay in implementing the increase, and lingering administrative challenges. CT ranks fourth lowest among states in physicians taking new Medicaid patients. Council members urged the state to track increases in provider participation before and after the rate increases.